Upper and Lower UTI Flashcards
What bacteria causes 85-90% of community-acquired UTI’s?
Escherochia Coli
What bacteria causes the other 5-10% of community-acquired UTI’s?
Staphylococcus sapraophyticus
What are some risks for UTI
Female Pregnancy Diabetes Paralysis Renal transplant Sickle cell disease Constipation Estrogen deficiency
What is the pathophysiology of a UTI?
When bacteria enter the bladder, there is increased micturition and diuresis to empty the bladder. Most pathogens enter the Urinary tract and ascend the urethra to the bladder.
Most of the microorganisms are from the fecal flora, but the vagina is an important source of infecting organisms. Bacteria that cause UTI’s originate in the fecal flora, colonize in the vagina and periurethral introitus and ascend to the urethra and bladder. In the bladder, the bacteria multiply and travel up the urethra to the renal pelvis and parenchyma, especially if there is vesicoureteral reflux.
The longer urethra in men increases the distance between the rectum and the urethral meatus, and teh drier environment around the urethra and the antibacterial activity of prostatic fluid also decrease the risk of UTIs in med.
What are the goals of therapy for a UTI?
Destroy the defending pathogen
Relieve urinary symptoms of urgency, frequency, and dysuria
Prevention of complications
Urinary Analgesics:
What is their purpose?
How long can they be used for?
Urinary Analgesics are NOT used to treat UTI’s, they are used for symptomatic relief of urgency, burning, frequency, and discomfort.
They should not be used longer than 48-72 hours.
What are some examples of urinary analgesics?
AZO - OTC
Urised (methenamine 2 tabs QID)
-May turn urine and feces flue or green
Pyridium 200 mg TID x 3 days
-May cause renal insufficiency
- May turn urine and feces orange
Flavoxate (Urispas) 100 -200 mg TID - QID x 3 days
Complicated UTI
Men, pregnancy, postmenopausal
Pyelonephritis
Uncomplicated UTI
Sexually active, premenopausal, nonpregnancy female without any recent history of UTI
Pyelonephritis
Upper UTI
Considered a complicated UTI
Positive Urine culture
Inpt: IV therapy if symptoms uncontrolled such as fever, weakness, chills, nausea, vomiting, flank/abd pain associated
Outpt: Use of fluoroquinolones 10-14 day treatment, if symptoms can be controlled.
First-Line Therapy for UTI
TMP-SMZ (Bactrim):
Adults: 1 DS tablet BID for 3 days
Children 5 mg/dg/d in divided doses for 10 days
Trimethoprim 100 mg BID for 3 days
Nitrofuratoin (Macrobid) 100 mg BID for 5-7 days
Second-Line Therapy for UTI
Fluroquinolones:
Uncomplicated UTI: Cipro 100-250 mg BID for 3 days
Complicated UTI: Cipro 100-250 mg BID for 7 days
Uncomplicated Pyelonephritis: Cipro 500 mg BID 10-14 days
TMP-SMZ 1 DS tablet BID for 7 days
Third-Line Therapy for UTI
Recurrent therapy
Use microbic
TMP-SMZ
TMP
What are some Lifestyle changes to reduce UTI’s?
Woman with recurrent UTI should use birth control without spermicides
Spermicides change vaginal flora
Increase intake of water
Voiding after intercourse
Avoiding bubble baths and feminine hygiene
What are some CAM for UTI?
Cranberry juice concentrate tablets inhibit adherence of E.Coli
Priobiotics: restore normal vaginal flora
Lactobacillus: Prevents colonization of E. Coli
Prophyllaxis for those who have 3 or more UTI’s a year is TMP-SMZ 40-200 mg daily or 3 times weekly can be used to prevent UTI.
